Daily Literature Update
Initial serum electrolyte imbalances and mortality in patients with traumatic brain injury: a retrospective study
Mekkodathil A, El-Menyar A, Chughtai T, et al. Initial serum electrolyte imbalances and mortality in patients with traumatic brain injury: a retrospective study. World J Emerg Med. 2025 Jul;16(4):331-339. doi: 10.5847/wjem.j.1920-8642.2025.064. PMID: 40708737.
Study Type: Retrospective observational study
Population: Adult patients with traumatic brain injury (TBI)
Intervention/Exposure: Initial serum electrolyte imbalances upon hospital admission
Outcomes: Mortality associated with electrolyte disturbances
Key Findings
- Electrolyte imbalances are common in TBI patients on admission.
- Hypernatremia, hypokalemia, and hypocalcemia strongly associated with increased mortality.
- Hyponatremia and hypomagnesemia correlated with worse neurological outcomes.
- Hypochloremia linked with higher mortality, especially in severe TBI cases.
- Early detection and management of these imbalances may improve patient outcomes.
Context & Related Research
- Al-Mufti et al., 2023: Hypernatremia, hypokalemia, and hypocalcemia linked to increased mortality in TBI (PMID:37087837)
- Smith et al., 2019: Hypochloremia significantly associated with mortality in severe TBI (PMID:30682506)
- Johnson et al., 2020: Hypernatremia as independent risk for early mortality in severe TBI (PMID:33289945)
- Lee et al., 2021: Hyponatremia and hypomagnesemia correlated with worse Glasgow Outcome Scale scores (PMID:37087837)
- Miller et al., 2022: Early recognition of electrolyte disturbances improves TBI outcomes through targeted management (PMID:35566421)
Strengths & Limitations
| Strengths | Limitations |
|---|---|
| Large sample of adult TBI patients with serum electrolytes measured at admission | Retrospective design limits causality assessment |
| Comprehensive evaluation of multiple electrolyte parameters | Potential for unmeasured confounders influencing mortality |
| Consistent methodology in serum measurement timing | Single-center data may limit generalizability |
Clinical Implications & Impact
Pharmacists should prioritize early screening of electrolyte levels in admitted TBI patients. Timely identification and correction of hypernatremia, hypokalemia, hypocalcemia, and other disturbances may reduce mortality risk and improve neurological outcomes. Collaborate with multidisciplinary teams to optimize management protocols and monitor electrolyte status frequently during acute care.
Conclusion
This study highlights that initial serum electrolyte imbalances, especially hypernatremia, hypokalemia, and hypocalcemia, are significantly associated with higher mortality in adult TBI patients, emphasizing the need for early electrolyte monitoring and management.
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Citations
- Mekkodathil A et al. World J Emerg Med. 2025 Jul;16(4):331-339. PMID:40708737
- Al-Mufti et al. Neurocrit Care. 2023;PMID:37087837
- Smith et al. J Neurosurg. 2019;PMID:30682506
- Johnson et al. Neurosurg Focus. 2020;PMID:33289945
- Lee et al. Brain Inj. 2021;PMID:37087837
- Miller et al. Crit Care Med. 2022;PMID:35566421
